Transitional Care May Cut Hospital Readmission Rates

MONDAY July 25, 2011 -- Older patients who complete transitional care programs after being discharged from the hospital are much less likely to be readmitted to the hospital, two new studies show.

These interventions could also reduce health-care costs, according to an editorial accompanying the studies published in the July 25 issue of the Archives of Internal Medicine.

"In the United States, 30-day all-cause readmission rates for patients 65 years or older generally range from 20 percent to 25 percent, depending on clinical condition and geographic region, indicating much room for improvement," the authors noted. "Interventions addressing patient- and systems-level factors show promise for reducing hospital readmissions."

In conducting the first study, researchers evaluated the success and effectiveness of 30-day interventions to help 257 older patients transition to health-care services outside the hospital. A coach completed the interventions, which included a hospital visit, a home visit and two follow-up telephone calls with the patients.

The researchers found that patients who participated in the intervention had a 12.8 percent hospital readmission rate. In contrast, those who did not participate had a significantly higher 20 percent rate of readmission, according to a journal news release.

"The Care Transitions Intervention appears to be effective in this real-world implementation," Rachel Voss, of Quality Partners or Rhode Island, and colleagues reported. "This finding underscores the opportunity to improve health outcomes beginning at the time of discharge in open health-care settings."

In a separate study, Dr. Brett Stauffer, of the Institute for Health Care Research and Improvement at Baylor Health Care System in Dallas, and colleagues evaluated a transitional care program led by advanced practice nurses for 56 patients aged 65 and older with heart failure. The program included an intervention before the patients were discharged from the hospital and at least eight house calls per patient after they left the hospital.

Stauffer's team found that hospital readmission rates were 48 percent lower among patients who completed the transitional care program than those who did not. The intervention, the researchers noted, had little effect on how long the patients were hospitalized or their 60-day direct health-care costs.

"Preliminary results suggest that transitional care programs reduce 30-day readmission rates for patients with heart failure," the authors wrote. "This underscores the potential of the intervention to be effective in a real-world setting, but payment reform may be required for the intervention to be financially sustainable by hospitals."

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